Aetna EPSDT PI Coordinator in Phoenix, Arizona

Req ID: 37889BR

POSITION SUMMARY

Improve health care quality by improving performance measure ratings, supports integration of physical health interventions into behavioral health settings. Audits medical records to monitor and improve quality indicators/HEDIS measures according to established technical requirements.

Fundamental Components:

AUDITS MEDICAL/DENTAL RECORDS AND OTHER DATA electronically, abstracts information and reports data with a minimum 95% accuracy rate. Process & evaluate complex data & information sets (e.g. regulations, HEDIS & other performance measure data, claims, contracts).

IMPROVES PERFORMANCE on assigned measures/projects via provider outreach, implementing PI projects based on evidence-based practices, and driving business to high-performing integrated providers.

COORDINATES WITH HEALTH CARE PROVIDERS to ensure receipt of behavioral and physical health EPSDT services for members aged 18-20 years old. Promotes individual preventive health strategies. Identifies and coordinates assistance for identified member needs. Collaborates/interfaces with community and system stakeholders as assigned.

MONITORS AND ENSURES COMPLIANCE with preventive health regulations from AHCCCS/CMS/ADHS on an ongoing basis throughout the year.

CREATES ACCURATE ELECTRONIC REPORTS AND REGULATORY RESPONSES using established technical guidelines to ensure business, contractual and regulatory requirements are met on time.

SUPPORTS DEPT in other activities as assigned.

BACKGROUND/EXPERIENCE:

4+ yrs healthcare experience. Maricopa County, AZ resident. AZ licensed LPN/RN. Intermediate: medical terminology, Excel, analyze data, use software/electronic tools. Fast-paced, paperless environment. Able to work cooperatively & professionally, meet deadlines despite competing priorities. Good business writing skills. Understand complex regulations & performance measures.

EDUCATION

The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Must be an AZ licensed LPN/RN, CPHQ or have a Master s degree in a related field

FUNCTIONAL EXPERIENCES

Nursing//4-6 Years

TECHNOLOGY EXPERIENCES

Desktop Tools/Microsoft Word/1-3 Years/End User

REQUIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

Benefits Management/Maximizing Healthcare Quality/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

DESIRED SKILLS

General Business/Maximizing Work Practices/ADVANCED

General Business/Turning Data into Information/ADVANCED

General Business/Demonstrating Business and Industry Acumen/FOUNDATION

Telework Specifications:

Telework is never guaranteed. A partial telework schedule will be considered based on successful job performance and business needs. An initial in-office training period in Phoenix, AZ is required. Must live in Maricopa County, Arizona.

ADDITIONAL JOB INFORMATION

This is a unique opportunity to be a part of health care history in Arizona by integrating physical and behavioral health care systems. Mercy Maricopa Integrated Care, administered by Aetna, is bringing a coordinated system of care that will lead to fewer lives lost to preventable and treatable physical illnesses.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Quality Management